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Fredens M, Palmhøj Nielsen C, Grønkjær M, Kjærside Nielsen B, Konstantin Nissen N, Benthien KS, Toft U, Rasmussen K, Kidholm K, Deleuran Terkildsen M. Nurses' perspectives on challenges and facilitators when implementing a self-management support intervention as an everyday healthcare practice: A qualitative study. J Adv Nurs 2024; 80:2475-2486. [PMID: 38012863 DOI: 10.1111/jan.15988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
AIM To explore registered nurses' perspectives on challenges and facilitators to implementing a telephone-based self-management support (SMS) intervention (Proactive Health Support) as an everyday healthcare practice, during the early stages of implementation. DESIGN Data were collected using a qualitative research design involving focus-group interviews and participant observations. METHODS We conducted participant observation following nine nurses and four focus group interviews with 14 nurses. Data were analysed using thematic analyses. RESULTS Proactive Health Support was implemented in units organized independently of the existing organizational units within healthcare services. This independent organization, along with the intervention's generic (non-disease specific) design, empowered nurses to become autonomous practitioners capable of prioritizing the operationalization of SMS as an everyday healthcare practice. However, unlearning already embedded medical practices and establishing new nursing roles necessary to accommodate the intervention in practice was experienced a challenge. Education and supervision were identified as valuable tools for successful implementation. CONCLUSION Our study highlights the significance of organizational context and autonomy in successful SMS implementation. Balancing external factors like organizational context, priority and time is vital, but navigating the internal shift in professional practice is equally crucial. Role transition processes can constitute challenges demanding accommodation. IMPLICATIONS FOR THE PROFESSION From a nursing perspective, this study highlights that practising SMS requires substantial training and education. Generic SMS interventions can introduce higher levels of contingency due to their versatile nature. Thus, equipping nurses with competencies that enable them to navigate this unpredictability flexibly is crucial. IMPACT Policymakers and administrators should allocate resources and support implementation processes in ways that accommodate both internal and external conditions to facilitate nurses in delivering effective SMS. REPORTING METHOD This study adheres to the SRQR guideline. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Mia Fredens
- DEFACTUM - Public Health Research, Central Denmark Region, Aarhus, Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM - Public Health Research, Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mette Grønkjær
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | - Kirstine Skov Benthien
- Palliative Care Unit, Copenhagen University Hospital, Hvidovre, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Ulla Toft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Knud Rasmussen
- Department of Data and Development Research, Zealand Region, Sorø, Denmark
| | - Kristian Kidholm
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Morten Deleuran Terkildsen
- DEFACTUM - Public Health Research, Central Denmark Region, Aarhus, Denmark
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Wong Chung R, Willemen A, Bakker A, Maaskant J, Voorman J, Becher J, Schuengel C, Alsem M. The development and validation of the S-scan-parental self-management support (S-scan - PS): A self-reflection tool for child healthcare professionals. Child Care Health Dev 2024; 50:e13223. [PMID: 38265134 DOI: 10.1111/cch.13223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 11/18/2023] [Accepted: 12/07/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Professionals providing self-management support to parents regarding the care for their child with a chronic condition nowadays is an important aspect of child healthcare. This requires professionals to orient themselves towards partnership and collaboration with parents. The aims of the current study were the development and validation of the S-Scan-Parental self-management Support (S-scan - PS) as a tool for healthcare professionals to reflect on their attitude and practices regarding the support for parental self-management. METHODS An existing instrument was adapted together with field experts for professionals to self-evaluate their support for self-management of parents. The resulting 36-item self-report questionnaire was filled in by healthcare professionals in the Netherlands working with children and their parents. Cognitive interviews, exploratory and confirmatory factor analysis (CFA), and test-retest reliability analysis were part of the development and validation process. RESULTS In total, 434 professionals, including physicians, physiotherapists, occupational therapists, and nurses, from 13 rehabilitation institutes and 5 medical centres participated. The cognitive interviews with child healthcare professionals indicated adequate face and content validity. The S-scan - PS scale had acceptable internal consistency (0.71 ≤ α ≤ 0.91) for the total score as well as the domain scores. CFA showed acceptable root mean square error of approximation (RMSEA) model fit (0.066), though not on other tested goodness-of-fit indices. Test-retest reliability of the instrument was moderate with an average intraclass correlation coefficient (ICC) = 0.61. CONCLUSIONS The S-scan - PS fulfils important psychometric criteria for use by child healthcare professionals to reflect on parental self-management support. Such self-reflection might help to improve their approach towards supporting self-management of parents in the care for their child with a chronic condition. Further research is needed into the construct validity and test-retest reliability of the instrument.
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Affiliation(s)
- Ruud Wong Chung
- Merem Medical Rehabilitation, Almere, The Netherlands
- Amsterdam Public Health Research Institute and Department of Educational and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Agnes Willemen
- Amsterdam Public Health Research Institute and Department of Educational and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Amber Bakker
- Amsterdam Public Health Research Institute and Department of Educational and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jolanda Maaskant
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Jeanine Voorman
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht and De Hoogstraat Rehabilitation Utrecht, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jules Becher
- Amsterdam Movement Sciences and Department of Rehabilitation Medicine, Amsterdam UMC - VU Medical Centre, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Carlo Schuengel
- Amsterdam Public Health Research Institute and Department of Educational and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- LEARN! Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mattijs Alsem
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Development of a Core Set of Self-Management Support Needs of Esophageal Cancer Patients: Results from a Delphi Study among Healthcare Professionals. Eur J Cancer Care (Engl) 2023. [DOI: 10.1155/2023/3164450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Objective. We aimed to gain consensus on HCPs’ perspectives on self-management support information needs of patients with esophageal cancer during the preoperative phase. Methods. Based on the literature, observations of clinical consultations, and hospital patient information leaflets, a survey was created. HCPs were surveyed twice about their opinion on importance of information, from “not essential” to “absolutely essential,” using Delphi methods. Topics were included in the second round if predetermined criteria were met. To be included in the final list, topics had to meet criteria for consensus and stability. Results. 64 information items and 6 sources of support were identified. Survey response rates were 59% (68 out of 116, first round) and 75% thereafter. The final list included 33 topics, including logistical information, expectations for future health condition, complications, follow-up care, nutrition during treatment, and nutrition during recovery as topics with 100% agreement. Consensus on the source of support was reached for face-to-face contact, written information, information video, and a case manager. Conclusion. This study provides a list of important topics, from the perspectives of HCPs, to guide the systematic provision of education to support EC patients’ self-management during the preoperative phase. Additionally, the most preferred sources of support were face-to-face contact and a case manager.
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Noorlandt H, Stoevelaar R, van Dongen S, Arslan M, Luu N, Kranenburg L, Witkamp E, van der Rijt C, Lorig K, van der Heide A, Rietjens J. Challenges in self-management of persons living with advanced cancer: An exploratory, in-depth interview study. Eur J Cancer Care (Engl) 2022; 31:e13638. [PMID: 35729779 PMCID: PMC9788059 DOI: 10.1111/ecc.13638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 05/23/2022] [Accepted: 06/06/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To obtain insight in self-management challenges of persons with advanced cancer and factors that influence their self-management. METHODS Exploratory study among persons with advanced cancer. We conducted in-depth interviews and performed an inductive thematic analysis, using open, axial and selective coding. RESULTS We interviewed 33 persons with advanced cancer. Four self-management challenges were identified: (1) Dealing with physical and psychological symptoms and problems. (2) Navigating the illness trajectory, including management of clinical appointments and treatment regimens, end-of-life planning life and 'maintaining normality'. (3) Managing relations with healthcare professionals, including contributing experiential knowledge to medical decision-making. (4) Navigating changes in the social environment. Some participants responded proactively to these challenges, for example, by actively searching for information to obtain an extensive understanding of their illness and (re)scheduling medical appointments for a better fit in their agenda. Self-management strategies seemed to be influenced by patients' personality, life history, moment in the illness trajectory and the social environment. CONCLUSION Self-management challenges of persons with advanced cancer are based largely outside the professional care setting. Self-management strategies in response to these challenges are typically aimed at maintaining a normal life. Self-management support should be tailored to patients' needs and part of trustful partnerships with patients and relatives.
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Affiliation(s)
- Hanna Noorlandt
- Department of Public HealthErasmus MC, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Rik Stoevelaar
- Department of Public HealthErasmus MC, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Sophie van Dongen
- Department of Public HealthErasmus MC, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Muzeyyen Arslan
- Department of Public HealthErasmus MC, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Nancy Luu
- Department of Public HealthErasmus MC, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Leonieke Kranenburg
- Department of Psychiatry, Section Medical Psychology and PsychotherapyErasmus MC, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Erica Witkamp
- Department of Public HealthErasmus MC, Erasmus University Medical CenterRotterdamThe Netherlands,Center of Expertise Innovations in CareRotterdam University of Applied SciencesRotterdamThe Netherlands
| | - Carin van der Rijt
- Department of Medical OncologyErasmus MC, University Medical CenterRotterdamThe Netherlands
| | - Kate Lorig
- Stanford School of MedicineStanfordCaliforniaUSA
| | - Agnes van der Heide
- Department of Public HealthErasmus MC, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Judith Rietjens
- Department of Public HealthErasmus MC, Erasmus University Medical CenterRotterdamThe Netherlands
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Self-Care and Sense of Coherence: A Salutogenic Model for Health and Care in Nursing Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159482. [PMID: 35954838 PMCID: PMC9368734 DOI: 10.3390/ijerph19159482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 02/01/2023]
Abstract
Background: Effective advocacy on self-care and the enhancement of a sense of coherence among nurses don’t only benefit control over one’s health and personal performance, but it may have a direct impact on clinical care and on the entire healing system. In this regard, nursing curricula grounded on a salutogenic model of health (SMH) operate with strategies to engage students in self-care and contribute to improving their mental health and wellbeing. The aim of this study was to explore the relationships between self-care agency and a sense of coherence as dependent variables and the age and self-reported academic performance as independent variables in nursing assistant students. Methods: For this cross-sectional study, data were collected from a full sample of 921 Certified Nursing Assistant (CNA) Spanish students. A self-administered questionnaire, including sociodemographic variables, the ‘appraisal of self-care agency’ (ASA), and the ‘sense of coherence’ (SOC) constructs, was administered. Results: Results: Older participants presented significantly stronger values of both constructs. Apart from a significant and positive correlation between ASAS and SOC, ANOVA analyses indicate signif-icant differences in terms of academic performance according to different ASAS and SOC de-grees. Conclusion: The findings of this study endorse the assumption that there is a consistent relationship between ASA and SOC constructs that might, indeed, have a potential effect on stu-dents’ academic performance. In practical terms, it seems relevant to try to recognise the stu-dents’ self-care agency and the sense of coherence as forceful predictive variables of mental health and wellbeing, in addition to academic success as a strength implied in the future career achievement.
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Hämel K, Röhnsch G, Heumann M, Backes DS, Toso BRGDO, Giovanella L. How do nurses support chronically ill clients' participation and self-management in primary care? A cross-country qualitative study. BMC PRIMARY CARE 2022; 23:85. [PMID: 35436847 PMCID: PMC9014774 DOI: 10.1186/s12875-022-01687-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 04/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the context of the advancement of person-centered care models, the promotion of the participation of patients with chronic illness and complex care needs in the management of their care (self-management) is increasingly seen as a responsibility of primary care nurses. It is emphasized that nurses should consider the psychosocial dimensions of chronic illness and the client's lifeworld. Little is known about how nurses shape this task in practice. METHODS The aim of this analysis is to examine how primary care nurses understand and shape the participation of patients with chronic illness and complex care needs regarding the promotion of self-management. Guided interviews were conducted with nurses practicing in primary care and key informants in Germany, Spain, and Brazil with a subsequent cross-case evaluation. Interpretive and practice patterns were identified based on Grounded Theory. RESULTS Two interpretive and practice patterns were identified: (1) Giving clients orientation in dealing with chronic diseases and (2) supporting the integration of illness in clients' everyday lives. Nurses in the first pattern consider it their most important task to provide guidance toward health-promoting behavior and disease-related decision-making by giving patients comprehensive information. Interview partners emphasize client autonomy, but rarely consider the limitations chronic disease imposes on patients' everyday lives. Alternatively, nurses in the second pattern regard clients as cooperation partners. They seek to familiarize themselves with their clients' social environments and habits to give recommendations for dealing with the disease that are as close to the client's lifeworld as possible. Nurses' recommendations seek to enable patients and their families to lead a largely 'normal life' despite chronic illness. While interview partners in Brazil or Spain point predominantly to clients' socio-economic disadvantages as a challenge to promoting client participation in primary health care, interview partners in Germany maintain that clients' high disease burden represents the chief barrier to self-management. CONCLUSIONS Nurses in practice should be sensitive to client's lifeworlds, as well as to challenges that arise as they attempt to strengthen clients' participation in care and self-management. Regular communication between clients, nurses, and further professionals should constitute a fundamental feature of person-centered primary care models.
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Affiliation(s)
- Kerstin Hämel
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany.
| | - Gundula Röhnsch
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
- Qualitative Social and Education Research, Department of Education and Psychology, Free University of Berlin, Habelschwerdter Allee 45, Berlin, 14195, Germany
| | - Marcus Heumann
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Dirce Stein Backes
- Franciscan University - UFN, Rua dos Andradas, 1614, Centro, Santa Maria, RS, CEP: 97010-030, Brazil
| | - Beatriz Rosana Gonçalves de Oliveira Toso
- Center of Biological and Health Sciences, Western Paraná State University - UNIOESTE, Rua Universitária, 1619, Jardim Universitário, Cascavel, PR, CEP 85819-110, Brazil
| | - Ligia Giovanella
- National School of Public Health, Fundação Oswaldo Cruz, Av Brasil 4036 s. 1001, Rio de Janeiro, RJ, CEP 21040-361, Brazil
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Cha E, Shin MH, Smart M, Jang H, Lee J, Joung KH, Kim HJ, Faulkner MS. Q-Methodology and Psychological Phenotyping to Design Patient-Centered Diabetes Education for Persons With Type 2 Diabetes on Insulin Therapy. Sci Diabetes Self Manag Care 2022; 48:98-110. [PMID: 35118919 DOI: 10.1177/26350106221076035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to identify the psychological phenotypes of persons with type 2 diabetes (T2D) on insulin therapy to better inform personalized diabetes education strategies to improve self-management behaviors. METHODS Q-methodology, a research approach combining the quantitative rigor of statistical analysis with qualitative data on perception of diabetes self-management by persons with T2D on insulin therapy, was used. The Summary of Diabetes Self-Care Activity measure and A1C in the past 6 months were used to further describe self-management behaviors of each P-sample, Q-sorter. Of 160 statements, 33 Q-sample statements were selected as Q-set. Then, 37 P-samples (24 men; 13 women) were recruited from a university-affiliated diabetes clinic in South Korea. Data obtained from each P-sample with a Q-set and a Q-sorting table, a forced-choice normal distribution table, were analyzed using varimax rotation. RESULTS Forty-one percent of the variance was explained with 5 factors represented by 27 Q-sorters, explaining variance ranging from 5% to 17% for each factor: Factor A (n = 6): those showing self-management education need but possessing inadequate health literacy; Factor B (n = 4): those valuing lifestyle modification to control diabetes; Factor C (n = 5): those valuing antidiabetic medication to control diabetes; Factor D (n = 6): carpe diem, accepting diabetes as destiny; and Factor E (n = 6): those overestimating their competencies to control diabetes. Ten Q-sorters fell into either confounded or nonsignificant. CONCLUSIONS Tailoring messages and educational approaches based on patients' psychological phenotypes are necessary to promote optimal self-management behaviors.
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Affiliation(s)
- EunSeok Cha
- College of Nursing, Chungnam National University, Daejeon, South Korea.,Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Myoung Hwan Shin
- School of Communication and Media, Sookmyung Women's University, Seoul, South Korea
| | - Michael Smart
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
| | - Hyesun Jang
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Jooseon Lee
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Kyong Hye Joung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Hyun Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Melissa Spezia Faulkner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.,Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
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van Dongen SI, Stoevelaar R, Kranenburg LW, Noorlandt HW, Witkamp FE, van der Rijt CCD, van der Heide A, Rietjens JAC. The views of healthcare professionals on self-management of patients with advanced cancer: An interview study. PATIENT EDUCATION AND COUNSELING 2022; 105:136-144. [PMID: 34034936 DOI: 10.1016/j.pec.2021.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 04/13/2021] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Self-management of patients with advanced cancer is challenging. Although healthcare professionals may play a crucial role in supporting these patients, scant scientific attention has been paid to their perspectives. Therefore, we examined healthcare professionals' views on self-management and self-management support in this population. METHODS We conducted qualitative interviews with 27 purposively sampled medical specialists (n = 6), nurse specialists (n = 6), general practitioners (n = 8) and homecare/ hospice nurses (n = 7) in the Netherlands. Transcripts were analysed using thematic analysis. RESULTS Healthcare professionals experienced self-management of patients with advanced cancer to be diverse, dynamic and challenging. They adopted instructive, collaborative and advisory roles in self-management support for this population. Whereas some professionals preferred or inclined towards one role, others indicated to switch roles, depending on the situation. CONCLUSIONS Just like patients with advanced cancer, healthcare professionals differ in their views and approaches regarding self-management and self-management support in this population. Therefore, instructive, collaborative and advisory self-management support roles will all be useful under certain circumstances. PRACTICE IMPLICATIONS Healthcare professionals can support self-management by being aware of their own views and communicating these clearly to their patients and colleagues. Education in self-management support should include self-reflection skills and discuss the relation between self-management and professional care.
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Affiliation(s)
- S I van Dongen
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - R Stoevelaar
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - L W Kranenburg
- Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - H W Noorlandt
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - F E Witkamp
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands; Faculty of Nursing and Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.
| | - C C D van der Rijt
- Department of Medical Oncology, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - A van der Heide
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - J A C Rietjens
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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Fischer H, Grønning K. Are We Transitioning Toward Person-centered Practice on Self-management Support? An Explorative Case Study Among Rheumatology Outpatient Clinic Nurses in Norway. SAGE Open Nurs 2021; 7:23779608211037494. [PMID: 34869855 PMCID: PMC8642106 DOI: 10.1177/23779608211037494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/18/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction There are only a few studies investigating nurses’ views on self-management
in the care of patients with rheumatic diseases. Objective The aim of this study is to explore how Norwegian rheumatology outpatient
nurses describe their ways of supporting patients’ self-management focusing
on the core dimensions of person-centered self-management support. Methods Ten individual semistructured interviews with rheumatology outpatient nurses
were conducted in Norway from March to September 2017. The interviews were
audiorecorded and transcribed verbatim. NVIVO was used to support a
systematic analysis of themes and patterns. Results Nurses’ views on self-management support fell into three approaches; (1)
narrowly biomedically orientated, (2) biomedically and holistic, and (3)
person-centered. The nurse's views of self-management support varied and did
not fully align with the core dimensions of person-centered practice. Conclusion The findings indicate that the biomedical paradigm continues to influence
Norwegian rheumatology outpatient clinic nurses’ approach to self-management
support. If person-centered principles of self-management support are to be
translated into standard nursing practice, including identifying and
supporting patient-defined self-management goals and processes, there is a
need to challenge established structures in health care systems.
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Affiliation(s)
| | - Kjersti Grønning
- Department of Public Health and Nursing, Norwegian University of Science and
Technology (NTNU), Trondheim, Norway
- Department of Rheumatology, St. Olavs hospital, Trondheim University
Hospital, Trondheim, Norway
- Kjersti Grønning, Department of Public
Health and Nursing, Norwegian University of Science and Technology (NTNU),
Postboks 8905, N-7491 Trondheim, Norway.
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Buljac-Samardzic M, Clark MA, van Exel NJA, van Wijngaarden JDH. Patients as team members: Factors affecting involvement in treatment decisions from the perspective of patients with a chronic condition. Health Expect 2021; 25:138-148. [PMID: 34598308 PMCID: PMC8849256 DOI: 10.1111/hex.13358] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/17/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Active patient involvement in treatment decisions is seen as a feature of patient-centred care that will ultimately lead to better healthcare services and patient outcomes. Although many factors have been identified that influence patient involvement in treatment decisions, little is known about the different views that patients have on which factors are most important. OBJECTIVE This study explores the views of patients with a chronic condition on factors influencing their involvement in treatment decisions. DESIGN Q-methodology was used to study the views of patients. Respondents were asked to rank a set of 42 statements from the least important to the most important for active patient involvement in treatment decision-making. The set of 42 statements was developed based on a literature search and a pilot in which two external researchers, 15 patients and four healthcare professionals participated. A total of 136 patients with one of three major chronic conditions were included: diabetes types 1 and 2, respiratory disease (i.e., chronic obstructive pulmonary disease and asthma) and cancer (i.e., breast cancer and prostate cancer). Data were collected in a face-to-face interview setting in the Netherlands. RESULTS Four distinct views on the factors influencing active patient involvement were identified among patients with a chronic condition. (1) Enabled involvement: the extent to which patients are facilitated and empowered to participate will lead to patient involvement. (2) Relationship-driven involvement: the relationship between patients and healthcare professionals drives patient involvement. (3) Disease impact-driven involvement: the severity of disease drives patient involvement. (4) Cognition-driven involvement: knowledge and information drive patient involvement. DISCUSSION AND CONCLUSION From the patients' perspective, this study shows that there is no one-size-fits-all approach to involving patients more actively in their healthcare journey. Strategies aiming to enhance active patient involvement among patients with a chronic condition should consider this diversity in perspectives among these patients. PATIENT CONTRIBUTION Patients are the respondents as this study researches their perspective on factors influencing patient involvement. In addition, patients were involved in pilot-testing the statement set.
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Affiliation(s)
- Martina Buljac-Samardzic
- Department Health Services Management and Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Mark A Clark
- Kogod School of Business, American University, Washington, DC, USA
| | - N Job A van Exel
- Department Health Economics, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jeroen D H van Wijngaarden
- Department Health Services Management and Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Evaluation of a Nurse-Led Patient Navigation Intervention: Follow-Up of Patients After Autologous and Allogeneic Stem Cell Transplantation. Cancer Nurs 2021; 45:287-296. [PMID: 34608045 DOI: 10.1097/ncc.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Complex survivorship cancer care requires nurse-led interventions. Therefore, a nurse-led patient navigation intervention was developed in which trained cancer nurses gave advice and referred to other professionals during the process of recovery and rehabilitation of hematopoietic stem cell transplantation (HSCT) patients. OBJECTIVE The aim of this study was to understand the nature and effect of this nurse-led information and referral intervention. METHODS Of the 199 included patients in the intervention group, 75 completed the quality of life, quality of care, self-efficacy, and self-management behavior questionnaires at baseline and at 6 and 12 months after HSCT. A historical control group of 62 patients completed the same questionnaires 12 months after HSCT. In addition, patients' experiences with the intervention were evaluated in 2 focus groups. RESULTS Patients emphasized the holistic approach of the cancer nurses and the opportunity to discuss psychosocial domains of life. Within the intervention group, a statistically significant effect on quality of life was demonstrated over time. The differences in quality of life, self-efficacy, and self-management were not significant between the intervention group and control group. CONCLUSION The holistic focus of this nurse-led intervention proved to be acceptable to the HSCT patients and promising in supporting the (complex) challenges that these patients face during their process of recovery and rehabilitation. IMPLICATIONS FOR PRACTICE Nurse-led patient navigation interventions with a holistic approach when included in the daily practice of complex survivorship cancer care can support HSCT patients' information and referral needs during their rehabilitation.
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Wong Chung R, Willemen A, Voorman J, Ketelaar M, Becher J, Schuengel C. Professionals' motivation to support parental self-management regarding children with physical disability in Dutch rehabilitation services: 'Please mind your gap'. Child Care Health Dev 2021; 47:685-696. [PMID: 34014585 PMCID: PMC8453492 DOI: 10.1111/cch.12883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 01/05/2021] [Accepted: 05/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Professionals in child healthcare increasingly endorse the support of self-management in paediatric rehabilitation services for children with physical disability. Less understood though are their views regarding the role of the children's parents, as well as their own role in supporting parents. This study aimed to investigate the motivation of rehabilitation professionals to support self-management of parents regarding their child with physical disability, professionals' beliefs about parental self-management, and the perceptions underlying their motivation. METHODS A mixed-methods strategy was followed using a survey among rehabilitation professionals (n = 175) and consecutive semi-structured interviews (n = 16). Associations between autonomous (intrinsic) versus controlled (extrinsic) motivation and beliefs on parental self-management were tested. For deeper understanding of their motivation, directed content analysis was used to address key themes in the qualitative data extracts. RESULTS Professionals reported autonomous motivation for parental self-management support more often than controlled motivation (t[174] = 29.95, p < .001). Autonomous motivation was associated with the beliefs about the importance of parental self-management (r = .29, p < .001). Approximately 90% of the professionals believed that parents should have an active role, though less than 10% considered it important that parents also are independent actors and initiative takers in the rehabilitation process. Interviews revealed that individual professionals struggled with striking a balance between keeping control and 'giving away responsibility' to parents. A 'professional-like' attitude was expected of parents with 'involvement' and 'commitment' as essential preconditions. Furthermore, professionals expressed the need for additional coaching skills to support parental self-management. CONCLUSION Professionals were predominantly autonomously motivated to support self-management of parents. However, the dilemmas in giving or taking responsibilities within the partnership with parents may limit their effectiveness in empowering parents. Reflection on the potential gaps between professionals' motivation, beliefs and actual behaviour might be crucial to support parental self-management.
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Affiliation(s)
- Ruud Wong Chung
- Merem Medical RehabilitationAlmereThe Netherlands,Amsterdam Public Health research institute and Department of Educational and Family studies, Faculty of Behavioural and Movement SciencesVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Agnes Willemen
- Amsterdam Public Health research institute and Department of Educational and Family studies, Faculty of Behavioural and Movement SciencesVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Jeanine Voorman
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain CentreUniversity Medical Centre Utrecht and De Hoogstraat Rehabilitation UtrechtUtrechtThe Netherlands,Department of Rehabilitation, Physical Therapy Science & Sports, Wilhelmina Children's HospitalUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Marjolijn Ketelaar
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain CentreUniversity Medical Centre Utrecht and De Hoogstraat Rehabilitation UtrechtUtrechtThe Netherlands
| | - Jules Becher
- Amsterdam Movement Sciences and Department of Rehabilitation MedicineAmsterdam UMC, VU Medical Centre, Amsterdam Movement SciencesAmsterdamThe Netherlands
| | - Carlo Schuengel
- Amsterdam Public Health research institute and Department of Educational and Family studies, Faculty of Behavioural and Movement SciencesVrije Universiteit AmsterdamAmsterdamThe Netherlands
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13
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Tharani A, Van Hecke A, Ali TS, Duprez V. Factors influencing nurses' provision of self-management support for patients with chronic illnesses: A systematic mixed studies review. Int J Nurs Stud 2021; 120:103983. [PMID: 34147728 DOI: 10.1016/j.ijnurstu.2021.103983] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Self-management support is considered an important task for nurses working in chronic care provision. The complex nature of self-management support makes it necessary to clarify the factors affecting the behaviour of nurses in supporting patients living with chronic illnesses. OBJECTIVE The aim of this review is to synthesize the factors influencing the provision of self-management support as perceived by nurses in the care for patients living with a chronic illness. DESIGN A systematic mixed studies review. DATA SOURCE Studies published in English from 1999 to April 2020 were extracted from five databases: CINAHL, PubMed, Cochrane library, EMBASE, and Web of Science. REVIEW METHOD The selection process was guided by PICo (Population, phenomenon of Interest, and Context). Studies that highlighted factors associated with the provision of self-management support among nurses, within the context of the top four non-communicable chronic diseases, were included. The risk of bias was carefully assessed. Using data-based convergent synthesis, the identified factors were synthesized and tabulated. The clusters of factors organized under each theme were approved by all researchers in discussion meetings. RESULTS In total, sixteen studies met the inclusion criteria; out of these, seven were qualitative, seven quantitative, and two mixed methods studies. The review identified nurses' perspectives regarding factors influencing self-management support at the patient, nurse, care relationship, education and training, organization and healthcare system, and intra- and inter-professional levels. The review provided evidence that these factors are interdependent in nature. CONCLUSION This review proposed considering a framework of interdependent factors influencing self-management support. It highlighted the need to come up with a comprehensive definition of self-management support that takes into account the emotional aspect as well as patient-as-partner approach. The proposed framework can be useful in tailoring multi-faceted interventions to strengthen nurses' supportive role in self-management of chronic care. Future studies should focus on exploring contextually relevant factors impacting nurses' supportive role in self-management.
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Affiliation(s)
- Ambreen Tharani
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Aga Khan University School of Nursing and Midwifery, Stadium Road, P.O Box 3500, Karachi, Pakistan.
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Nursing Department, Ghent University Hospital, Ghent, Belgium.
| | - Tazeen Saeed Ali
- Aga Khan University School of Nursing and Midwifery, Stadium Road, P.O Box 3500, Karachi, Pakistan.
| | - Veerle Duprez
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
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Cho H, Han K, Ryu E. Unit work environment, psychological empowerment and support for patient activation among nurses. J Nurs Manag 2021; 29:1623-1630. [PMID: 33690900 DOI: 10.1111/jonm.13307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/19/2021] [Accepted: 03/08/2021] [Indexed: 11/29/2022]
Abstract
AIMS To investigate the relationship between the unit work environment and psychological empowerment of nurses and their perceptions of patient activation. BACKGROUND Nurses' support for active patient roles in the care process is critical for better patient outcomes. The factors influencing nurses' support for patient activation should be thoroughly investigated. METHODS This study was a cross-sectional secondary data analysis using the survey data of 1,042 nurses in 98 units at six hospitals in Korea. RESULTS Nurses with perceptions that their work was valuable and autonomy in their work were more likely to work in units where managers had greater managerial and leadership skills and staffing and resources were sufficient. Those with confidence in their work were more likely to work in units with adequate staffing and resources. Nurses who worked with adequate staffing and resources and considered their work meaningful were more likely to perceive patient activation as more important. CONCLUSION Favourable work environments at unit level and psychological empowerment at nurse level can strengthen nurses' support for patient activation. IMPLICATIONS FOR NURSING MANAGEMENT To strengthen nurses' support for active patient roles, organisations should ensure optimal staffing and resources to each unit and help nurses find value in their work.
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Affiliation(s)
- Hyeonmi Cho
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA
| | - Kihye Han
- Chung-Ang University College of Nursing, Seoul, South Korea
| | - Eunjung Ryu
- Chung-Ang University College of Nursing, Seoul, South Korea
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15
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Team Members' Roles in Home Healthcare: Evidence From the "AKEΣΩ-1" Project in Greece. Home Healthc Now 2020; 38:318-326. [PMID: 33165102 DOI: 10.1097/nhh.0000000000000907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Home healthcare has just recently won the interest of policy decision makers in Greece and there is a lack of knowledge regarding the contributions provided by each team member. The aim of this study was to describe the home care interventions carried out by nurses, physicians, and physiotherapists during the AKEΣΩ-1 project. We examined the data from 1,094 patients who received home healthcare (HHC) from an interdisciplinary team from the Hellenic Red Cross HHC services in three major cities in Greece during a 20-month period. The visits and interventions by nurses, physicians, and physiotherapists were grouped and measured. Patients were mostly older adults (80.73%), women (68.37%) with medical problems (46.8%). Nurses conducted 70.76% of the visits, and provided 21,017 interventions. Physiotherapists conducted 22.83% of the visits and 4,627 interventions, and physicians conducted 6.4% of the visits and 2,117 interventions. Nurses provided a wide range of complex skilled nursing interventions that required knowledge of the community and ability to network. Physiotherapy and educating patients and caregivers were the most frequent interventions of physiotherapists. The main role of physicians was to conduct clinical exams. The Greek healthcare system is hospital- and physician-oriented. We documented that in HHC, nurses take a lead role in providing care, organizing services, and collaborating with other community services. From a health and social policy perspective, proper planning and staffing of HHC services are required. From an academic and licensing perspective, it is important to ensure that nurses working in the community have appropriate preparation.
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16
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Tobiano G, Jerofke‐Owen T, Marshall AP. Promoting patient engagement: a scoping review of actions that align with the interactive care model. Scand J Caring Sci 2020; 35:722-741. [DOI: 10.1111/scs.12914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/22/2020] [Accepted: 09/07/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Georgia Tobiano
- Nursing and Midwifery Education and Research Unit Gold Coast Health Southport Qld Australia
- Menzies Health Institute Queensland Griffith University Southport Qld Australia
| | | | - Andrea P. Marshall
- Nursing and Midwifery Education and Research Unit Gold Coast Health Southport Qld Australia
- Menzies Health Institute Queensland Griffith University Southport Qld Australia
- School of Nursing and Midwifery, Griffith University Southport Qld Australia
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17
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Bijnsdorp FM, Pasman HRW, Boot CRL, van Hooft SM, van Staa A, Francke AL. Profiles of family caregivers of patients at the end of life at home: a Q-methodological study into family caregiver' support needs. BMC Palliat Care 2020; 19:51. [PMID: 32316948 PMCID: PMC7175554 DOI: 10.1186/s12904-020-00560-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family caregivers of patients at the end of life often experience care-related burden. To prevent caregiver burden and to enhance the capacity to provide care it is important to have insight in their support needs. The purpose of this study was to identify profiles of family caregivers who provide care to patients at the end of life at home. METHODS A Q-methodological study was conducted in which family caregivers ranked 40 statements on support needs and experiences with caregiving. Thereafter they explained their ranking in an interview. By-person factor analysis was used to analyse the rankings and qualitative data was used to support the choice of profiles. A set of 41 family caregivers with a variety on background characteristics who currently or recently provided care for someone at the end of life at home were included. RESULTS Four distinct profiles were identified; profile (1) those who want appreciation and an assigned contact person; profile (2) was bipolar. The positive pole (2+) comprised those who have supportive relationships and the negative pole (2-) those who wish for supportive relationships; profile (3) those who want information and practical support, and profile (4) those who need time off. The profiles reflect different support needs and experiences with caregiving. CONCLUSIONS Family caregivers of patients at the end of life have varying support needs and one size does not fit all. The profiles are relevant for healthcare professionals and volunteers in palliative care as they provide an overview of the main support needs among family caregivers of patients near the end of life. This knowledge could help healthcare professionals giving support.
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Affiliation(s)
- Femmy M Bijnsdorp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Cécile R L Boot
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Susanne M van Hooft
- Research Centre Innovations in Care, Rotterdam University, Rotterdam, The Netherlands
| | - AnneLoes van Staa
- Research Centre Innovations in Care, Rotterdam University, Rotterdam, The Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Anneke L Francke
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.,Nivel, Netherlands institute for health services research, Utrecht, The Netherlands
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18
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Duprez V, Beeckman D, Van Hecke A, Verhaeghe S. Nurses' perceptions of success in self‐management support: An exploratory qualitative study. Res Nurs Health 2020; 43:274-283. [DOI: 10.1002/nur.22018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/27/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Veerle Duprez
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University Centre for Nursing and MidwiferyGhent University Ghent Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University Centre for Nursing and MidwiferyGhent University Ghent Belgium
- School of Nursing & MidwiferyRoyal College of Surgeons in Ireland (RCSI) Dublin Ireland
- School of Health SciencesÖrebro University Örebro Sweden
| | - Ann Van Hecke
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University Centre for Nursing and MidwiferyGhent University Ghent Belgium
- Nursing departmentGhent University Hospital Ghent Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University Centre for Nursing and MidwiferyGhent University Ghent Belgium
- Department Health CareVIVES University College Roeselare Belgium
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19
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van Dongen SI, de Nooijer K, Cramm JM, Francke AL, Oldenmenger WH, Korfage IJ, Witkamp FE, Stoevelaar R, van der Heide A, Rietjens JA. Self-management of patients with advanced cancer: A systematic review of experiences and attitudes. Palliat Med 2020; 34:160-178. [PMID: 32009565 PMCID: PMC7433395 DOI: 10.1177/0269216319883976] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with advanced cancer are increasingly expected to self-manage. Thus far, this topic has received little systematic attention. AIM To summarise studies describing self-management strategies of patients with advanced cancer and associated experiences and personal characteristics. Also, to summarise attitudes of relatives and healthcare professionals towards patient self-management. DESIGN A systematic review including non-experimental quantitative and qualitative studies. Data were analysed using critical interpretive synthesis. Included studies were appraised on methodological quality and quality of reporting. DATA SOURCES MEDLINE, Embase, Cochrane Central, PsycINFO, CINAHL, Web of Science and Google Scholar (until 11 June 2019). RESULTS Of 1742 identified articles, 31 moderate-quality articles describing 8 quantitative and 23 qualitative studies were included. Patients with advanced cancer used self-management strategies in seven domains: medicine and pharmacology, lifestyle, mental health, social support, knowledge and information, navigation and coordination and medical decision-making (29 articles). Strategies were highly individual, sometimes ambivalent and dependent on social interactions. Older patients and patients with more depressive symptoms and lower levels of physical functioning, education and self-efficacy might have more difficulties with certain self-management strategies (six articles). Healthcare professionals perceived self-management as desirable and achievable if based on sufficient skills and knowledge and solid patient-professional partnerships (three articles). CONCLUSION Self-management of patients with advanced cancer is highly personal and multifaceted. Strategies may be substitutional, additional or even conflicting compared to care provided by healthcare professionals. Self-management support can benefit from an individualised approach embedded in solid partnerships with relatives and healthcare professionals.
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Affiliation(s)
- Sophie I van Dongen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kim de Nooijer
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jane M Cramm
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Anneke L Francke
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Amsterdam Public Health (APH) Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Wendy H Oldenmenger
- Faculty of Nursing and Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frederika E Witkamp
- Faculty of Nursing and Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Rik Stoevelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Judith Ac Rietjens
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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20
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Franklin M, Willis K, Lewis S, Rogers A, Smith L. Between knowing and doing person-centredness: A qualitative examination of health professionals’ perceptions of roles in self-management support. Health (London) 2019; 25:339-356. [DOI: 10.1177/1363459319889087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Self-management is a contemporary model of chronic condition care that places expectations on, and roles for, both patients and health professionals. Health professionals are expected to form partnerships with their patients, and patients are expected to be active participants in their own care. In these new roles, control and responsibility for self-management are shared between people with chronic conditions and their health professionals. We still have limited knowledge about how these new roles are enacted in self-management support. In this article, we examine how health professionals perceive the roles of patients and professionals in chronic condition self-management, drawing on Bourdieu’s concepts of field, doxa and capital. In this qualitative study, 32 in-depth interviews were conducted with 11 health professionals in Sydney, Australia. Data were analysed thematically. Three themes were derived. First, there was incongruence between how participants characterised and enacted their roles. Second, participants compartmentalised clinical and non-clinical aspects of self-management support. Finally, the roles of health professionals entwined with emotions and judgements of patienthood revealed that the provision of self-management support was linked to a fit between individuals’ cultural health capital and the expectations governing the field. We argue that ‘taken for granted’ assumptions about self-management and self-management support must be challenged to mitigate negative social representations and unrealistic expectations placed on patients and health professionals, particularly those patients with less capital, who are more marginalised within clinical interactions.
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Affiliation(s)
| | - Karen Willis
- La Trobe University, Australia
- The Royal Melbourne Hospital, Australia
| | - Sophie Lewis
- University of New South Wales, Sydney, Australia
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21
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Doekhie KD, Strating MMH, Buljac‐Samardzic M, Paauwe J. Trust in older persons: A quantitative analysis of alignment in triads of older persons, informal carers and home care nurses. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1490-1506. [PMID: 31347234 PMCID: PMC6852099 DOI: 10.1111/hsc.12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 06/18/2019] [Accepted: 07/08/2019] [Indexed: 06/10/2023]
Abstract
Self-management by older persons could be influenced by the level of trust found in triads of informal carers, formal care providers and care recipient, the older person. Little research has been done on care providers' trust in older persons. This study aims to explore the level of trust that informal carers and home care nurses have in older persons, the extent of alignment in triads and the relationship between trust in older persons and self-management. We conducted a cross-sectional survey study in the Netherlands, sampling 133 older persons, 64 informal carers and 72 nurses, which resulted in 39 triads. Alignment level was analysed through Intraclass Correlation Coefficient 1 scores and absolute and mean difference scores. Correlation analysis and one-way analysis of variance measured the relationship between trust and self-management. The results show that triads contain both alignment and misalignment. Misalignment occurs mostly when informal carers and nurses have little trust in the older person while this person views their own behaviour towards their caregivers positively. Care providers' trust levels relate significantly to their perception of the person's ability to self-manage, but not to the person's self-rated ability. This could be explained by care providers not communicating their intrinsic trust in the older person to them. Trust building could be enhanced by organising discussions of mutual expectations of trust and both formal and informal care providers could benefit from compassionate assessment training, to learn how to openly express their trust in the older person.
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Affiliation(s)
- Kirti D. Doekhie
- Erasmus School of Health Policy & Management (ESHPM)Erasmus University RotterdamRotterdamThe Netherlands
| | - Mathilde M. H. Strating
- Erasmus School of Health Policy & Management (ESHPM)Erasmus University RotterdamRotterdamThe Netherlands
| | - Martina Buljac‐Samardzic
- Erasmus School of Health Policy & Management (ESHPM)Erasmus University RotterdamRotterdamThe Netherlands
| | - Jaap Paauwe
- Erasmus School of Health Policy & Management (ESHPM)Erasmus University RotterdamRotterdamThe Netherlands
- Department of Applied EconomicsErasmus University RotterdamRotterdamThe Netherlands
- Department of Human Resource StudiesTilburg UniversityTilburgThe Netherlands
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22
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van den Heuvel SCGH, Goossens PJJ, Terlouw C, Schoonhoven L, van Achterberg T. Self-Management Education for Bipolar Disorders: A Hermeneutic-Phenomenological Study on the Tacit Knowledge of Mental Health Nurses. Issues Ment Health Nurs 2019; 40:942-950. [PMID: 31381457 DOI: 10.1080/01612840.2019.1636166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Self-management of bipolar disorder (BD) education is a complex nursing intervention in which patients and informal caregivers are taught to be actively involved in self-monitoring and self-regulating activities. Some studies question if nurses are sufficiently equipped to deliver these educational tasks. Other studies suggest that nurses have gathered their knowledge implicitly by experience, but to date, this tacit knowledge is not described from the experiences of mental health nurses (MHNs) in ambulant BD care. Objective: To detect the tacit knowledge used by MHNs by interpreting their experiences in delivering self-management education to people with BD and their informal caregivers. Methods: A phenomenological-hermeneutical study amongst MHNs (N = 9) from three ambulant BD care clinics in the Netherlands. Face-to-face, open, in-depth interviews guided by a topic list, were conducted and transcribed verbatim prior to the hermeneutical analysis. Findings: We found five categories resembling the complex character of self-management interventions provided by MHNs: Building a trustful collaboration, Starting a dialogue about needs and responsibilities, Explaining BD, Utilizing mood monitoring instruments, and Conceptualizing self-management of BD. Conclusion: Eventually MHNs use tacit knowledge to cope with situations that demand an outside-the-box approach. Self-management education is partially trained and partially mastered through experience. Practice implications: In order to facilitate long-term self-management of BD, the collaboration of a supporting network is essential.
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Affiliation(s)
- S C G H van den Heuvel
- Expertise Centre for Health, Social Care and Technology, Saxion University of Applied Sciences , Deventer , The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare , Nijmegen , The Netherlands.,Dimence Group, Center for Mental Health Care, SCBS Bipolar Disorders , Deventer , The Netherlands.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven , Leuven , Belgium
| | - P J J Goossens
- Dimence Group, Center for Mental Health Care, SCBS Bipolar Disorders , Deventer , The Netherlands.,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University Centre for Nursing and Midwifery, Ghent University , Ghent , Belgium
| | - C Terlouw
- Expertise Centre for Educational Innovations, Saxion University of Applied Sciences , Deventer , the Netherlands
| | - L Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University , Utrecht , the Netherlands.,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton , Southampton , UK
| | - T van Achterberg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare , Nijmegen , The Netherlands.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven , Leuven , Belgium
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23
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Chung A, Kinsey DF. An examination of different perspectives on philanthropic corporate social responsibility. JOURNAL OF GLOBAL RESPONSIBILITY 2019. [DOI: 10.1108/jgr-04-2019-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to identify different perspectives on philanthropic corporate social responsibility (CSR) activities by using the mixed-method approach and Q methodology. In addition, this study examines why people consider the revealed perspectives to be important factors.
Design/methodology/approach
In this study, the authors used a structured sampling of 30 CSR-related statements (a Q sample) and had participants rank-order the statements from “most important” (+4) to “most unimportant” (−4).
Findings
The results, from the factor analysis and correlation using the Q method software program PQMETHOD, revealed two distinctive perspectives. The first group emphasized the importance of supporting environmental-related activities. The second group ranked supporting arts-related activities as the most important factor of philanthropic CSR activities.
Research limitations/implications
The goal of Q methodology is not the generalizability of the results but to identify the different views that exist regarding a topic, even minority ones. The findings are discussed in terms of practical implications for how this framework can be used to understand the subjective papers of different types of stakeholders.
Originality/value
This study identifies the different perspectives that exist regarding philanthropic CSR activities by using Q methodology, which is a good alternative to other research methods that provides a unique way of uncovering subjectivity from the participants’ point of view.
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Been-Dahmen JMJ, Beck DK, Peeters MAC, van der Stege H, Tielen M, van Buren MC, Ista E, van Staa A, Massey EK. Evaluating the feasibility of a nurse-led self-management support intervention for kidney transplant recipients: a pilot study. BMC Nephrol 2019; 20:143. [PMID: 31029107 PMCID: PMC6486974 DOI: 10.1186/s12882-019-1300-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 03/18/2019] [Indexed: 12/14/2022] Open
Abstract
Background To support effective self-management after kidney transplantation, a holistic nurse-led self-management support intervention was developed using the Intervention Mapping approach. The primary aim was to evaluate the feasibility, acceptability and fidelity of the intervention for kidney transplant recipients and professionals. The secondary aim was to explore preliminary effects on outcomes. Methods A pilot study was conducted in 2015–2017 to evaluate the intervention. Nurse Practitioners (NP) guided recipients in assessing 14 life areas using the Self-Management Web. Participants were supported in developing self-regulation skills which can be applied to self-management of the illness. Strategies included goal setting, action planning, and promotion of motivation and self-efficacy. Adult recipients from an outpatient clinic of a Dutch University Hospital who underwent their transplant at least 1 month ago, were invited to participate. NPs, nephrologists and recipients were interviewed to assess feasibility, fidelity and implementation experience. Consultations were videoed and analysed to assess fidelity. To assess the preliminary effects, the intervention group completed baseline (T0) and follow-up (T1) questionnaires on self-management behavior, self-efficacy, quality of life and quality of care. A historical control group of kidney transplant recipients completed the same questionnaires at T1. Results Twenty-seven recipients agreed to participate in the intervention group, of which 24 completed the intervention and 16 completed baseline and follow-up surveys. The control group consisted of 33 recipients. Professionals and recipients appraised the open, holistic focus of the intervention as a welcome addition to standard care and felt that this helped to build a relationship of trust. Recipients also felt they became more competent in problem-solving skills. The within-group analysis showed no significant increase in patients’ self-management skills. The between-groups analysis showed significantly higher medication adherence among the intervention group (P = 0.03; G = 0.81). The within-groups analysis showed a significantly higher perceived quality of care (P = 0.02) in the intervention group. Conclusion This holistic nurse-led self-management support intervention was found to be feasible and acceptable by professionals and recipients alike. This pilot had a small sample therefore further research is needed into the potential effects on self-management behavior and well-being of transplant recipients. ISRCTN Trial Registry: ISRCTN15057632 (registered retrospectively on 20-07-2018). Electronic supplementary material The online version of this article (10.1186/s12882-019-1300-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Janet M J Been-Dahmen
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001, Rotterdam, HA, the Netherlands.,Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands
| | - Denise K Beck
- Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands
| | - Mariëlle A C Peeters
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001, Rotterdam, HA, the Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, the Netherlands
| | - Heleen van der Stege
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001, Rotterdam, HA, the Netherlands
| | - Mirjam Tielen
- Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands
| | - Marleen C van Buren
- Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands
| | - Erwin Ista
- Department of Internal Medicine - Section Nursing Science, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands.,Intensive Care Unit, Erasmus MC University Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000, Rotterdam, DR, the Netherlands
| | - AnneLoes van Staa
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001, Rotterdam, HA, the Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, the Netherlands
| | - Emma K Massey
- Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands.
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Cerna K, Ivarsson J, Weilenmann A, Steineck G. Supporting self-management of radiation-induced bowel and bladder dysfunction in pelvic-cancer rehabilitation: An ethnographic study. J Clin Nurs 2019; 28:2624-2634. [PMID: 30865355 DOI: 10.1111/jocn.14849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 02/06/2019] [Accepted: 02/09/2019] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To describe and understand strategies that oncological nurses use to support self-management of radiation-induced bowel and bladder issues in pelvic-cancer rehabilitation patients. BACKGROUND Nurse-led self-management of radiation-induced bowel and bladder issues holds the potential to support cancer survivors. DESIGN An ethnographic approach was applied in this study, which adhered to Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. METHODS Data collection was conducted in Sweden between October 2015-April 2018, involving observations of nurses' daily work, formal and informal interviews, individual and group interviews, and reviews of relevant documents used in the studied practice. Furthermore, 15 supportive nurse-patient talks were observed, and an ethnographic analysis was performed. RESULTS The analysis identified the following three categories of nursing strategies that support self-management of radiation-induced bowel and bladder issues in pelvic-cancer rehabilitation patients: encouraging self-reflection, tailoring solutions together and keeping patients motivated. Nurses and patients jointly make sense of patients' symptoms using data that patients collect about themselves. Based on their shared understanding, they can co-create solutions to meet each individual patient's needs and develop routines to keep the patient motivated in performing the devised solutions. CONCLUSIONS The results indicate that the strategies nurses use to support patients in self-management of radiation-induced bowel and bladder issues entail intertwining patients' experiences with their nurses' medical knowledge and specific clinical practice. Nurses' strategies build on their ability to connect patients' experiences and the elements of their own work practice. RELEVANCE TO CLINICAL PRACTICE A deeper understanding of nurses' strategies to support self-management of radiation-induced bowel and bladder issues in pelvic-cancer rehabilitation patients can improve other self-management programmes, inform nurses' education and aid in the design of tools for pelvic-cancer rehabilitation support.
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Affiliation(s)
- Katerina Cerna
- Department of Education, Communication, and Learning, University of Gothenburg, Gothenburg, Sweden
| | - Jonas Ivarsson
- Department of Education, Communication, and Learning, University of Gothenburg, Gothenburg, Sweden
| | | | - Gunnar Steineck
- Department of Oncology at Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
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Kenward L. A literature review to guide novice researchers using Q methodology in the development of a framework for concourse management. Nurse Res 2019; 27:17-21. [PMID: 31468831 DOI: 10.7748/nr.2019.e1616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND For novice Q methodology researchers, the development of the concourse is challenging. This challenge is exacerbated by the paucity of literature focusing on the development of the concourse. AIM To highlight the lack of strategy related to concourse development in Q methodology literature and to undertake a selected literature review to suggest frameworks for concourse development to guide researchers. DISCUSSION A limited search conducted using CINAHL PLUS appraised the variety of concourse strategies used in Q studies. Of 44 papers located, 23 used no strategy while the others used one of four types of strategy: thematic, profession-specific, broader healthcare and social care frameworks or a framework that the researchers devised specifically for their research. CONCLUSION The Q methodology literature frequently lacks discussion about the development of the concourse. Therefore, studies that focus on concourse development should be a focus of future research, along with the further development of the ideas put forward in this paper for possible frameworks. IMPLICATIONS FOR PRACTICE This paper will raise awareness inside and outside the Q methodology community that novice researchers want to use Q methodology but may require more detail about how to construct robust concourses.
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Smartphone-Based Remote Self-Management of Chronic Low Back Pain: A Preliminary Study. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:4632946. [PMID: 30881606 PMCID: PMC6381588 DOI: 10.1155/2019/4632946] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/19/2017] [Accepted: 11/19/2018] [Indexed: 02/05/2023]
Abstract
Objective To assess the additional effect of self-management on physiotherapy via the use of APPS on management of chronic low back pain. Method A single-blinded randomized control trial was conducted. 8 participants (male: 4; female: 4) were recruited from the Rehabilitation Clinic of The Hong Kong Polytechnic University. Participants in the treatment group received self-management plus physiotherapy and the control group received physiotherapy only. Assessment was carried out pretreatment, midterm (week 2), and posttreatment (week 4), including Visual Analog Scale (VAS), Pain Self-Efficacy Questionnaire (PSEQ), Roland Morris Disability Questionnaire (RMDQ), and SF36. Results Compared with the physiotherapy group, the self-management plus physiotherapy group had significance in PSEQ (p=0.035), RMDQ (p=0.035), SF36-Bodily Pain (p=0.008), and SF36-Mental Health (p=0.013). VAS showed a positive trend although there was no significant difference. Conclusion This pilot study indicated that smartphone APPS-based self-management program appears to bring additional benefits to physiotherapy for patients with CLBP. Self-management is a potential approach for people with CLBP.
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28
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Brackney DE. Enhanced self-monitoring blood glucose in non-insulin-requiring Type 2 diabetes: A qualitative study in primary care. J Clin Nurs 2018; 27:2120-2131. [PMID: 29603813 DOI: 10.1111/jocn.14369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To contribute to both theoretical and practical understanding of the role of self-monitoring blood glucose for self-management by describing the experience of people with non-insulin-requiring Type 2 diabetes in an enhanced structured self-monitoring blood glucose intervention. BACKGROUND The complex context of self-monitoring blood glucose in Type 2 diabetes requires a deeper understanding of the clients' illness experience with structured self-monitoring of blood glucose. Clients' numeracy skills contribute to their response to blood glucose readings. Nurses' use of motivational interviewing to increase clients' regulatory self-efficacy is important to the theoretical perspective of the study. DESIGN A qualitative descriptive study. METHODS A purposive sample of eleven adults recently (<2 years) diagnosed with non-insulin-requiring Type 2 diabetes who had experienced a structured self-monitoring blood glucose intervention participated in this study. Audio recordings of semi-structured interviews and photographs of logbooks were analysed for themes using constant comparison and member checking. RESULTS The illness experience states of Type 2 diabetes include 'Diagnosis,' 'Behavior change,' and 'Routine checking.' People check blood glucose to confirm their Type 2 diabetes diagnosis, to console their diabetes-related fears, to create personal explanations of health behaviour's impact on blood glucose, to activate behaviour change and to congratulate their diabetes self-management efforts. CONCLUSIONS These findings support the Transtheoretical model's stages of change and change processes. Blood glucose checking strengthens the relationships between theoretical concepts found in Diabetes Self-management Education-Support including the following: engagement, information sharing and behavioural support. RELEVANCE TO CLINICAL PRACTICE Tailoring diabetes care specifically to clients' stage of their illness experience with use of self-monitoring blood glucose contributes to engagement in self-management. Motivational interviewing and collaborative decision-making using blood glucose checking increase regulatory self-efficacy for people living with non-insulin-requiring Type 2 diabetes.
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Affiliation(s)
- Dana Elisabeth Brackney
- Department of Nursing, Beaver College of Health Sciences, Appalachian State University, Boone, North Carolina
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29
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Doekhie KD, Strating MMH, Buljac-Samardzic M, van de Bovenkamp HM, Paauwe J. The different perspectives of patients, informal caregivers and professionals on patient involvement in primary care teams. A qualitative study. Health Expect 2018; 21:1171-1182. [PMID: 30221463 PMCID: PMC6250873 DOI: 10.1111/hex.12824] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/18/2018] [Accepted: 07/13/2018] [Indexed: 12/05/2022] Open
Abstract
Background Patient involvement in the decision‐making process, especially for chronically ill elderly patients, has become an important element of patient‐centred primary care in many countries, including the Netherlands. This study openly explores different perspectives of patients, informal caregivers and primary care professionals on patient involvement in primary care team interactions. Methods Sixty‐four qualitative semi‐structured interviews with chronically ill elderly patients, informal caregivers and primary care professionals from various disciplines. Underpinned by a phenomenology approach, this study used conventional content analysis for data analysis. Results Participants have different views of the roles of patients and informal caregivers in the primary care team and thus different expectations of the extent and level of patient involvement. Three challenges impact patient involvement in the team: (a) patients feel misunderstood and less involved that they would like when professionals take control, (b) patients have to balance the conflicting opinions of different professionals and (c) informal caregivers act undesirably as team leaders due to their own view of the level of patient involvement. Discussion and conclusion Patient involvement is formed in complex interactions between patients, informal caregivers and multiple professionals whose perspectives and expectations can be misaligned. Recognizing the value of patients and informal caregivers on the team could help professionals to understand them better and thus limit the likelihood of challenges arising in team interactions.
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Affiliation(s)
- Kirti D Doekhie
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Mathilde M H Strating
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Martina Buljac-Samardzic
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Hester M van de Bovenkamp
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jaap Paauwe
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands.,Department of Applied Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Department of Human Resource Studies, Tilburg University, Tilburg, The Netherlands
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30
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Simões de Almeida R, Sousa T, Marques A, Queirós C. Patients’ perspectives about the design of a mobile application for psychotic disorders. PSYCHOLOGY, COMMUNITY & HEALTH 2018. [DOI: 10.5964/pch.v7i1.192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Aim
Based on the design of applications for psychotic disorders illness self-management, this study aimed to understand patients’ patterns of technology usage, as well as their expectations and requirements concerning the design of an app for rehabilitation and illness management purposes. It also aimed to identify guidelines for mobile application development for this population.
Method
After a literature review, a questionnaire was developed, focused on behaviours and opinions about technology usage. It was applied, through a cross-sectional study, to a sample of 102 users of mental health services with psychotic disorders (62% men; with ages between 22 and 66 years old).
Results
Nearly 59% of the participants were willing to download an app for illness self-management, and 51% evaluated as essential the self-management of their mental health condition. However, correlation analysis revealed that the more years with mental illness, the less importance is given to an app for this purpose.
Conclusion
The use of mobile technologies seems to the have potential to empower individuals with mental health problems, especially younger ones and those in early disease stages. Concerns about privacy/security should be considered, as well as simple screening designs and texts. The results also reveal the importance of user participatory design.
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Been‐Dahmen JMJ, Grijpma JW, Ista E, Dwarswaard J, Maasdam L, Weimar W, Van Staa A, Massey EK. Self‐management challenges and support needs among kidney transplant recipients: A qualitative study. J Adv Nurs 2018; 74:2393-2405. [DOI: 10.1111/jan.13730] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/14/2018] [Accepted: 04/04/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Janet M. J. Been‐Dahmen
- Research Center Innovations in Care Rotterdam University of Applied Sciences Rotterdam The Netherlands
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Jan Willem Grijpma
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Erwin Ista
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
- Intensive Care Unit Erasmus MC University Medical Center‐Sophia Children's Hospital Rotterdam The Netherlands
| | - Jolanda Dwarswaard
- Research Center Innovations in Care Rotterdam University of Applied Sciences Rotterdam The Netherlands
| | - Louise Maasdam
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Willem Weimar
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
| | - AnneLoes Van Staa
- Research Center Innovations in Care Rotterdam University of Applied Sciences Rotterdam The Netherlands
| | - Emma K. Massey
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
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Van Wely L, Boiten JC, Verhoef J, Eijckelhof BH, Van Hooft SM, Van Staa A, Roelofs PD. Perspectives of Dutch Physiotherapists on Self-Management Support: A Q-Methodology Study. Physiother Theory Pract 2018; 35:318-326. [PMID: 29474105 DOI: 10.1080/09593985.2018.1443182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Self-management support programs are reported to have positive effects on the health and care of people with physical disabilities. It is unclear how physiotherapists (PTs) view self-management support. A cross-sectional study with mixed-methods design using Q-methodology was conducted to determine the perspectives of Dutch PTs on self-management support. PTs (n = 39) rank-ordered 37 validated statements about self-management support from "most disagree (-3)" to "most agree (+3)." Differences in perspectives on self-management support were explored in a by-person centroid factor analysis on the basis of the explained variance (R2). After having sorted the statements, PTs explained their ranking of -3 and +3 statements in semi-structured interviews. All PTs recognized self-management support as intrinsic part of physiotherapy practice. Nevertheless, four particular perspectives could be identified: (1) the "externally driven educator" (R2 = 14%), (2) "internally driven educator" (R2 = 9%), (3) "client-centered coach" (R2 = 13%), and (4) "client-initiated coach" perspective (R2 = 15%). Each perspective reflects particular goals and perceptions of self-management support. Differences were identified with respect to the PTs' role perception (educating or coaching), drive (external or internal), and collaboration with the patient (as partner or not). The identified perspectives can be used in the physiotherapy education curriculum to create awareness about the various ways of practicing self-management support and the skills needed to be able to tailor support to patient needs and to switch between perspectives.
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Affiliation(s)
- Leontien Van Wely
- a Faculty of Health, Physiotherapy , University of Applied Sciences Leiden , Leiden , The Netherlands
| | - Jeannette C Boiten
- a Faculty of Health, Physiotherapy , University of Applied Sciences Leiden , Leiden , The Netherlands
| | - John Verhoef
- b Department of Self-management, Faculty of Health , University of Applied Sciences Leiden , Leiden , The Netherlands
| | - Belinda Hw Eijckelhof
- a Faculty of Health, Physiotherapy , University of Applied Sciences Leiden , Leiden , The Netherlands
| | - Susanne M Van Hooft
- c Research Centre Innovations in Care , Rotterdam University of Applied Sciences , Rotterdam , The Netherlands
| | - AnneLoes Van Staa
- c Research Centre Innovations in Care , Rotterdam University of Applied Sciences , Rotterdam , The Netherlands
| | - Pepijn Ddm Roelofs
- c Research Centre Innovations in Care , Rotterdam University of Applied Sciences , Rotterdam , The Netherlands
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Lelorain S, Bachelet A, Bertin N, Bourgoin M. French healthcare professionals' perceived barriers to and motivation for therapeutic patient education: A qualitative study. Nurs Health Sci 2017; 19:331-339. [PMID: 28681481 DOI: 10.1111/nhs.12350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 01/20/2023]
Abstract
Therapeutic patient education is effective for various patient outcomes; however, healthcare professionals sometimes lack the motivation to carry out patient education. Surprisingly, this issue has rarely been addressed in research. Therefore, this study explores healthcare professionals' perceived barriers to and motivation for therapeutic patient education. Healthcare professionals, mainly nurses, working in different French hospitals were interviewed. Thematic content analysis was performed. Findings included a lack of skills, knowledge, and disillusionment of the effectiveness of therapeutic patient education were features of a demotivated attitude. In contrast, a positive attitude was observed when therapeutic patient education met a need to work differently and more effectively. A key factor motivating professionals was the integration of therapeutic patient education in routine care within a multidisciplinary team. To keep healthcare professionals motivated, managers should ensure that therapeutic patient education is implemented in accordance with its core principles: a patient-centered approach within a trained multidisciplinary team. In the latter case, therapeutic patient education is viewed as an efficient and rewarding way to work with patients, which significantly motivates healthcare professionals.
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Affiliation(s)
- Sophie Lelorain
- University of Lille, CNRS, Teaching Hospital of Lille, UMR 9193 - SCALab - Cognitive & Affective Sciences, Lille, France
| | - Adeline Bachelet
- University of Lille, CNRS, Teaching Hospital of Lille, UMR 9193 - SCALab - Cognitive & Affective Sciences, Lille, France
| | - Nicole Bertin
- Teaching Hospital of Lille, Transversal Unit of Patient Education, Lille, France
| | - Maryline Bourgoin
- Teaching Hospital of Lille, Transversal Unit of Patient Education, Lille, France
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Srulovici E, Key C, Rotem M, Golfenshtein N, Balicer RD, Shadmi E. Diabetes Conversation Map™ and health outcomes: A systematic literature review. Int J Nurs Stud 2017; 70:99-109. [PMID: 28242506 DOI: 10.1016/j.ijnurstu.2017.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/01/2017] [Accepted: 02/03/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To identify, describe, and assess the evidence regarding the effects that the Diabetes Conversation Map™ program, an educational tool that engages patients with diabetes in group discussions about diabetes-related topics, has over a range of patient outcomes. STUDY DESIGN A systematic review. DATA SOURCES Five databases, including PubMed, CINAHL, Scopus, EMBASE, and Cochrane Collaboration, were utilized to identify studies that evaluated the Conversation Map™ program. Additionally, the reference lists of the identified studies were manually reviewed. REVIEW METHODS Studies that evaluated the Conversation Map™ program since 2005 were included. Non-English languages, non-journal papers, and studies that only included a description of the program were excluded. A quality assessment of relevant studies was performed. Outcomes were grouped into: objective (e.g., HbA1c levels), subjective (e.g., self-efficacy), and health behaviors (e.g., medication adherence). RESULTS Of the 85 studies originally identified, 24 studies were included in the final sample. The overall methodological quality of the studies was intermediate (score: 17 of 28). Almost all studies examined objective health measures, with most indicating non-significant differences between the Conversation Map™ intervention and the control groups. Conflicting results were found regarding the influence the program had on HbA1c. The majority of studies reported no significant change in blood pressure and mixed results were found regarding other health indicators. Twelve studies examined subjective measures and 11 assessed the effects on health behaviors, mostly reporting non-significant or positive findings. CONCLUSIONS Our review shows that although the Diabetes Conversation Map™ program holds the potential to improve patient behaviors and outcomes, current research on the program provides limited support as to their relationship with positive patient outcomes. Larger, more sophisticated studies are needed in order to determine the potential influence Conversation Map™ can have on long-term health outcomes.
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Affiliation(s)
- Einav Srulovici
- School of Nursing, University of Haifa, Haifa, Israel; Clalit Research Insitute, Clalit Health Services, Tel Aviv, Israel.
| | - Calanit Key
- Community Nursing Division, Clalit Health Services, Tel Aviv, Israel
| | - Mina Rotem
- Community Nursing Division, Clalit Health Services, Tel Aviv, Israel
| | | | - Ran D Balicer
- Clalit Research Insitute, Clalit Health Services, Tel Aviv, Israel
| | - Efrat Shadmi
- School of Nursing, University of Haifa, Haifa, Israel; Clalit Research Insitute, Clalit Health Services, Tel Aviv, Israel
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35
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Kulnik ST, Pöstges H, Brimicombe L, Hammond J, Jones F. Implementing an interprofessional model of self-management support across a community workforce: A mixed-methods evaluation study. J Interprof Care 2016; 31:75-84. [DOI: 10.1080/13561820.2016.1246432] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stefan Tino Kulnik
- Faculty of Health, Social Care and Education, Kingston University and St. George’s, University of London, London, UK
- Bridges Self-Management Limited, London, UK
| | - Heide Pöstges
- Faculty of Health, Social Care and Education, Kingston University and St. George’s, University of London, London, UK
- Bridges Self-Management Limited, London, UK
| | - Lucinda Brimicombe
- Faculty of Health, Social Care and Education, Kingston University and St. George’s, University of London, London, UK
- Bridges Self-Management Limited, London, UK
| | - John Hammond
- Faculty of Health, Social Care and Education, Kingston University and St. George’s, University of London, London, UK
| | - Fiona Jones
- Faculty of Health, Social Care and Education, Kingston University and St. George’s, University of London, London, UK
- Bridges Self-Management Limited, London, UK
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36
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van Hooft SM, Dwarswaard J, Bal R, Strating MM, van Staa A. What factors influence nurses’ behavior in supporting patient self-management? An explorative questionnaire study. Int J Nurs Stud 2016; 63:65-72. [DOI: 10.1016/j.ijnurstu.2016.08.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 08/22/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
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37
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Jones F, Pöstges H, Brimicombe L. Building Bridges between healthcare professionals, patients and families: A coproduced and integrated approach to self-management support in stroke. NeuroRehabilitation 2016; 39:471-480. [DOI: 10.3233/nre-161379] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Fiona Jones
- Faculty of Health Social Care and Education, St Georges University of London and Kingston University, London, UK
| | - Heide Pöstges
- Faculty of Health Social Care and Education, St Georges University of London and Kingston University/Bridges Self-Management, London, UK
| | - Lucinda Brimicombe
- Faculty of Health Social Care and Education, St Georges University of London and Kingston University/Bridges Self-Management, London, UK
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Grijpma JW, Tielen M, van Staa AL, Maasdam L, van Gelder T, Berger SP, Busschbach JJ, Betjes MGH, Weimar W, Massey EK. Kidney transplant patients' attitudes towards self-management support: A Q-methodological study. PATIENT EDUCATION AND COUNSELING 2016; 99:836-843. [PMID: 26682972 DOI: 10.1016/j.pec.2015.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/11/2015] [Accepted: 11/20/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Kidney transplant recipients face many self-management challenges. We aimed to identify profiles of attitudes towards self-management support (SMS) shortly after kidney transplantation. METHODS Profiles were generated using Q-methodology: In face-to-face interviews participants rank-ordered opinion statements on aspects of SMS according to agreement. Socio-demographic and medical characteristics were assessed using a questionnaire. By-person factor analysis was used to analyze the rankings and qualitative data was used to support choice of profiles. The resulting factors represent clusters of patients with similar attitudes towards SMS. RESULTS Forty-three patients (mean age=56; 77% male) participated. Four profiles were identified: (A) transplant-focused and obedient; (B) holistic and collaborative; (C) life-focused and self-determined; and (D) was bipolar. The positive pole (D+) minimalizing and disengaged and the negative pole (D-) coping-focused and needy represent opposing viewpoints within the same profile. Socio-demographic and medical characteristics were not related to profile membership. DISCUSSION Each profile represents a specific attitude on post-transplant life, responsibility for health and decision-making, SMS needs, and preferences for SMS. PRACTICAL IMPLICATIONS Patients vary in their attitude, needs and preferences for SMS indicating the necessity of providing personalized support after kidney transplantation. Health professionals should explore patients' SMS needs and adapt support accordingly.
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Affiliation(s)
- J W Grijpma
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - M Tielen
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - A L van Staa
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, P.O. Box 25035, 3001 HA Rotterdam, The Netherlands; Erasmus University Rotterdam, Institute of Health Policy & Management (iBMG), Rotterdam, The Netherlands.
| | - L Maasdam
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - T van Gelder
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - S P Berger
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - J J Busschbach
- Erasmus MC, Department of Psychiatry, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - M G H Betjes
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - W Weimar
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - E K Massey
- Erasmus MC, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
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Stone TE, Kang SJ, Cha C, Turale S, Murakami K, Shimizu A. Health beliefs and their sources in Korean and Japanese nurses: A Q-methodology pilot study. NURSE EDUCATION TODAY 2016; 36:214-220. [PMID: 26577748 DOI: 10.1016/j.nedt.2015.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 09/03/2015] [Accepted: 10/19/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Many health beliefs do not have supporting scientific evidence, and are influenced by culture, gender, religion, social circumstance and popular media. Nurses may also hold non-evidenced-based beliefs that affect their own health behaviours and their practices. OBJECTIVES Using Q-methodology, pilot Q-cards representing a concourse of health beliefs for Japanese and South Korean nurses and explain the content and sources of health beliefs. DESIGN Qualitative. SETTINGS Two university campuses, one each in Japan and Korea. PARTICIPANTS A convenience sample of 30 was obtained, 14 clinical nurses and 16 academic nurses. METHODS Literature reviews and expert informants were used to develop two sets of 65 Q-cards which listed culturally appropriate health beliefs in both Japan and Korea. These beliefs were examined in four structured groups and five individual interviews in Japan, and five groups and two individual interviews in Korea. RESULTS Our unique study revealed six categories regarding sources of health beliefs that provide rich insights about how participants accessed, processed and transmitted health information. They were more certain about knowledge from their specialty area such as that from medical or nursing resources, but derived and distributed many general health beliefs from personal experience, family and mass media. They did not always pass on accurate information to students or those in their care, and often beliefs were not based on scientific evidence. CONCLUSION Findings highlight the dangers of clinical and academic nurses relying on health belief advice of others and passing this on to patients, students or others, without mindfully examining the basis of their beliefs through scientific evidence.
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Affiliation(s)
- Teresa E Stone
- Yamaguchi University, Faculty of Health Sciences, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Sook Jung Kang
- College of Nursing, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, South Korea.
| | - Chiyoung Cha
- College of Nursing, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, South Korea.
| | - Sue Turale
- College of Nursing, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, South Korea.
| | - Kyoko Murakami
- Yamaguchi University, Faculty of Health Sciences, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Akihiko Shimizu
- Yamaguchi University, Faculty of Health Sciences, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
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Been-Dahmen JM, Dwarswaard J, Hazes JM, van Staa A, Ista E. Nurses' views on patient self-management: a qualitative study. J Adv Nurs 2015; 71:2834-45. [DOI: 10.1111/jan.12767] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Janet M.J. Been-Dahmen
- Rotterdam University of Applied Sciences; Research Center Innovations in Care; The Netherlands
- Erasmus Medical Center; Rheumatology Department; The Netherlands
| | - Jolanda Dwarswaard
- Rotterdam University of Applied Sciences; Research Center Innovations in Care; The Netherlands
| | | | - AnneLoes van Staa
- Rotterdam University of Applied Sciences; Research Center Innovations in Care; The Netherlands
- Erasmus University Rotterdam; Institute of Health Policy & Management; The Netherlands
| | - Erwin Ista
- Erasmus Medical Center-Sophia Children's Hospital; Intensive Care Unit; Rotterdam The Netherlands
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Dwarswaard J, van de Bovenkamp H. Self-management support: A qualitative study of ethical dilemmas experienced by nurses. PATIENT EDUCATION AND COUNSELING 2015; 98:1131-1136. [PMID: 26070469 DOI: 10.1016/j.pec.2015.05.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 05/11/2015] [Accepted: 05/23/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Policymakers increasingly focus their attention on stimulating patients' self-management. Critical reflection on this trend is often limited. A focus on self-management does not only change nurses' activities, but also the values underlying the nurse-patient relationship. The latter can result in ethical dilemmas. METHODS In order to identify possible dilemmas a qualitative study consisting of semi-structured interviews was conducted. Six experts on self-management and medical ethics and 15 nurses participated. RESULTS Nurses providing self-management support were at risk of facing three types of ethical dilemmas: respecting patient autonomy versus reaching optimal health outcomes, respecting patient autonomy versus stimulating patient involvement, and a holistic approach to self-management support versus safeguarding professional boundaries. CONCLUSION The ethical dilemmas experienced by nurses rest on different views about what constitutes good care provision and good self-management. Interviewed nurses had a tendency to steer patients in a certain direction. They put great effort into convincing patients to follow their suggestions, be it making the 'right choice' according to medical norms or becoming actively involved patients. PRACTICE IMPLICATIONS Because self-management support may result in clashing values, the development and implementation of self-management support requires deliberation about the values underlying the relationship between professionals and patients.
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Affiliation(s)
- Jolanda Dwarswaard
- Research Centre Innovations of Care, Rotterdam University of Applied Sciences, The Netherlands; Department of Health Policy & Management, Erasmus University Rotterdam, The Netherlands.
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Dwarswaard J, Bakker EJM, van Staa A, Boeije HR. Self-management support from the perspective of patients with a chronic condition: a thematic synthesis of qualitative studies. Health Expect 2015; 19:194-208. [PMID: 25619975 DOI: 10.1111/hex.12346] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Receiving adequate support seems to be crucial to the success of self-management. Although different empirical studies separately examined patients' preferences for self-management support (SMS), an overview is lacking. OBJECTIVE The aim of this qualitative review was to identify patients' needs with respect to SMS and to explore by whom this support is preferably provided. SEARCH STRATEGY Qualitative studies were identified from Embase, MEDLINE OvidSP, Web of science, PubMed publisher, Cochrane central, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO. INCLUSION CRITERIA Articles needed to meet all of the following criteria: (i) focuses on self-management, (ii) concerns adult patients with rheumatic diseases (rheumatoid arthritis and fibromyalgia), a variant of cancer or chronic kidney disease, (iii) explores support needs from the patients' perspective, (iv) uses qualitative methods and (v) published in English. DATA EXTRACTION AND SYNTHESIS A thematic synthesis, developed by Thomas and Harden, was conducted of the 37 included studies. MAIN RESULTS Chronic patients need instrumental support, psychosocial support and relational support from health-care professionals, family/friends and fellow patients to manage the chronic condition. Relational support is at the centre of the support needs and fuels all other types of support. DISCUSSION AND CONCLUSIONS Patients do not self-manage on their own. Patients expect health-care professionals to fulfil a comprehensive role. Support needs can be knitted together only when patients and professionals work together on the basis of collaborative partnership. Dynamics in support needs make it important to regularly assess patient needs.
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Affiliation(s)
- Jolanda Dwarswaard
- Research Centre Innovations of Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ellen J M Bakker
- Research Centre Innovations of Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - AnneLoes van Staa
- Research Centre Innovations of Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Hennie R Boeije
- Department of Methodology and Statistics, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
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